Cleft palate is the most frequently occurring facial birth defect in the United States. Even following palate repair, many children will experience delayed speech and language well into the second year of life. Findings from our current R01 project show that greater than 40% of children with repaired cleft palate do not achieve emergence of stop consonants by 16 months of age (4 to 6 months following palate repair) and approximately 20% do not by 20 months of age (8 to 10 months following palate repair). By school age, 20% to 30% of children with repaired cleft palate will require secondary palatal surgery for obligatory symptoms of velopharyngeal dysfunction and 60% to 70% will require speech therapy for articulation. One of the most common errors is backed (palatalized) production of alveolar targets. The specific aims of this proposed renewal are to determine: 1) if a novel aerodynamic measure of velopharyngeal closure for stop consonants at 24 months of age predicts velopharyngeal function at 3, 4, and 5 years of age in children with repaired cleft palate, 2) age-related changes in obligatory symptoms of velopharyngeal dysfunction ? hypernasality and audible nasal air escape ? of children with repaired cleft palate from 5 to 8 years of age, and 3) the effects of cleft type and hearing status on the development of alveolar stop and fricative targets in children with repaired cleft palate from 5 to 8 years of age. We will continue to follow three currently enrolled cohorts of children: 1) with repaired cleft palate (approximately 60), 2) without cleft palate but with history of early otitis media with effusion (approximately 30), and 3) typically-developing without cleft palate or history of otitis media with effusion (approximately 30). We will also enroll additional 2 and 5 year-old children to offset attrition and maintain adequate sample sizes. We will use nasal ram pressure, standard pressure-flow procedures, perceptual ratings, and spectral moment analyses to accomplish the specific aims. We will evaluate the first specific aim using binomial regression and sensitivity/specificity analyses. We will evaluate the second and third specific aims using one-way analysis of variance and linear mixed models with and without cleft type and hearing status as covariates. It is anticipated that the results will a) further validate a novel and relatively simple procedure to evaluate velopharyngeal function in young children with repaired cleft palate, b) provide longitudinal data on obligatory symptoms and articulation of older children with repaired cleft palate, and c) contribute to theories of early speech development of children with structural anomalies. Such information will be instrumental to optimize the timing of secondary surgeries and provide evidence-based strategies for behavioral interventions that will improve oral communication and quality of life.